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Health In recent years, unprecedented progress has been made in reducing maternal and child mortality, and in the fight against malnutrition and infectious diseases. The under-five mortality rate has declined by more than half since 1990 and the maternal mortality ratio has declined by 45 per cent worldwide in the same period. However, despite this significant progress, there are huge global disparities and about five million children under the age of five still die each year from preventable causes. Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth, with 99 per cent of all maternal deaths occurring in developing countries. The risk of complications and death in adolescents because of pregnancy is far greater in comparison to other women. GOAL s health programmes include nutrition and access to safe water and sanitation and primarily target women, children and young people. These members of society remain the most vulnerable to poor health outcomes for a variety of reasons, including cultural norms, social status and lack of economic empowerment. In 2016, GOAL supported health, nutrition and Water, Sanitation and Hygiene (WASH) programmes across 13 countries. GOAL operates in many varied contexts, from acute emergency or chronic crisis to stable development contexts. Where feasible, the organisation works in collaboration with government ministries and local authorities, local partners, local communities and the private sector to help ensure sustainable results. GOAL s key approaches to improving health include health, nutrition and WASH systems strengthening, governance and accountability, social and behaviour change, as well as emergency humanitarian health, nutrition and WASH responses. Health systems strengthening sees GOAL work in partnership with a country s Ministry of Health and other stakeholders to try build the capacity of a country s health systems by facilitating analysis and dialogue to identify gaps and challenges. GOAL also tries to find local solutions, including the mentoring of district and national health staff. Through the organisation s governance and accountability work, GOAL helps ensure that strong relationships exist between the local community
and the health system structure that facilitates support communities demand of quality health services. GOAL uses social and behaviour change approaches to address barriers to health and increase the responsibility of individuals, families and communities towards their own health and well-being. When required, GOAL also implements emergency humanitarian health interventions. This could include a response to public health emergencies such as the Ebola outbreak in Sierra Leone, as well as emergency health service provision in conflict-affected areas of South Sudan and Sudan. Understanding that water, sanitation and hygiene are critical components for a healthy life is not difficult. However, for many of the people living in the countries that GOAL works in, accessing safe water, good sanitation and developing good hygiene behaviours is a constant struggle that they must deal with every day. benefits of improved access. Where the context is less stable for instance in a crisis state or after a natural disaster, or where the infrastructure simply does not exist GOAL or its local partners may implement water supply or sanitation systems directly and then train community and government staff to ensure that the systems can be sustained. GOAL s nutrition programming aims to help disadvantaged communities improve their nutritional status in a variety of ways. Nutrition programmes are designed to tackle the multifarious causes of undernutrition in a bid to prevent individuals from becoming affected, as well as supporting the provision of quality treatment services for individuals already suffering from malnutrition. Where possible, we work with existing structures such as communities, governments and the private sector. GOAL also supports emergency nutrition interventions if required in situations such as severe drought or population displacement due to conflict. Where GOAL WASH programmes exist in relatively stable contexts, they focus on building long term, sustainable access to water and sanitation services and to develop lasting behaviours within the communities that will maximise the
In Ethiopia, GOAL s health programme which includes community health promotion, nutrition, WASH and health systems strengthening reached more than 28,300 direct beneficiaries across 36 neighbourhoods. As part of this, GOAL also reached students, domestic and commercial sex workers with key HIV prevention messages, and provided business skills training for people living with HIV. More than 18,600 people benefitted from access to a clean water supply. In response to the severe drought in parts of Ethiopia that resulted in high levels of malnutrition, GOAL scaled up operational support to the government to provide quality integrated management of acute malnutrition services from 862 health facilities in 2015 to 1,900 health facilities in 2016. GOAL s work in India ensured that seasonal migrant workers at 35 of Kolkata s brick kilns had access to maternal and child health care, and WASH services, while more than 8,000 people living in and around two municipal dump sites in Kolkata and Howrah received access to healthcare, sanitation and other vital services. In Kenya, GOAL s health programme reached almost 40,000 beneficiaries. This included the construction of a community water point in the informal settlement of Makuru that provided clean water to 200 households. Using a healthy systems strengthening approach, GOAL improved youth-friendly health services by supporting Kenya s Ministry of Health to establish this programme in three existing urban facilities. GOAL s core programming strategy in Malawi included an integrated health, nutrition and WASH component. Nutrition Impact and Positive Practice (NIPP) a community-based, participatory approach to directly tackle the underlying behavioural causes of malnutrition was a key element of this. In total, 98 NIPP circles were facilitated, and introduced a multitude of interventions aimed at raising awareness about nutritious foods and promoting malnutrition screening and referrals amongst the targeted communities. Community rural water supply and sanitation was another significant area of focus in Malawi, and successes here included the rehabilitation of 70 boreholes. GOAL is also currently leading a consortium of organisations to implement a four-year, Youth as Agents of Change project that promotes the increased adoption of positive behaviours related to climate change adaptation and sexual reproductive health and family planning services amongst young people. This project is taking place in three districts in southern Malawi, and is reaching close to 28,000 people. In Niger, GOAL established NIPP circles in 65 villages, with the aim of supporting over 3,900 participants to address the causes of moderate acute malnutrition in the household. Activities included culinary demonstrations (using local food and vegetables from family gardens); the promotion of hand-washing techniques and improved stoves for cooking; and the construction or repair of communal latrines, water tanks and hand-washing points. GOAL also supported 33 health facilities in Zinder region on health systems strengthening. This primarily focused on the integration of services for the treatment of severe acute malnutrition and reached approximately 15,000 people. In Sierra Leone, GOAL s community health initiatives continued in Kenema, Kambia and Bombali Districts and in the capital, Freetown, where the team focused on nutrition and the health of women and children under the age of five. GOAL also implemented a community health approach in five districts, where health messages delivered through community dialogue sessions and radio messaging reached almost 56,000 people and increased the up-take of reproductive health services. GOAL also continued health systems strengthening with District Health Management Teams for services delivery. This included improving the physical and operational conditions in primary health care facilities; strengthening service delivery to Ebola survivors; and building capacity for the early detection and response to Ebola and other communicable diseases. GOAL also worked to improve access to quality reproductive, maternal, neonatal and child health services in Bombali district. The project supported 78 Peripheral Health Units (PHUs) in Bombali district. GOAL also constructed and repaired several water and sanitation systems in Freetown, including the rebuilding of a Gravity Flow System that now provides water to 11,500 people.
In South Sudan, GOAL rolled out Nutrition Sensitive Care Groups for the first time. These groups 15 in total were formed to promote peer-to-peer learning and uptake of nutrition, food security, hygiene and health education and behaviour change amongst women, who, in turn, feed what they learn down to their respective communities. GOAL also helped train mothers to use Mid-Upper Arm Circumference (MUAC) tapes. These tapes are used to measure the upper arm circumference of children and other vulnerable groups to help identify malnutrition. In the long term, this approach will encourage communities to regard malnutrition detection as a household-level task, rather than a function of health and nutrition facilities. GOAL also continued to support 56 health facilities to provide a basic package of primary health care to over half a million people in areas where the government is currently unable to provide adequate services. In Sudan, GOAL s health programmes in Kassala reached more than 14,200 men and women through partners, and benefitted 6,000 people directly in Kutum (North Darfur). GOAL s School Health Club approach, which aims to transform thinking around hygiene and sanitation practices, immunization and nutrition, sexual disease transmission and reproductive health, and the prevention of communicable diseases, reached almost 148,000 children across 77 schools in Kassala and Kutum. GOAL also created access to sanitation facilities for more than 9,300 people in Kassala and North Darfur; constructed latrines, showers and hand-washing stations at five health facilities in Kutum, and implemented 44 pairs (male and female) of Nutrition Impact and Positive Practice (NIPP) circles across North Darfur. GOAL continued to build on the largest water, sanitation and hygiene (WASH) programme in northern Syria, reaching more than 550,000 people with safe water across 133 towns and villages. GOAL also supported the operation of 15 hygiene units that, between them, manage 10 landfills and remove approximately 50,000 m³ of domestic waste throughout the year, benefitting approximately 444,770 people. In Uganda, GOAL s robust WASH programme saw the construction of almost 6,900 latrines and more than 7,800 hand washing facilities. In addition, 97 communities became open-defecation free ; 164 water-user committee members were trained on the operation and management of village water points; and 53 water points were repaired. GOAL Accountability Can Transform (ACT) health programme supports active community engagement in health services with a view to improving the quality and up-take of the services. The programme was implemented in 375 health facilities across 16 districts. In Zimbabwe, GOAL reached more than 22,400 people through the extended Nutrition Impact and Positive Practices Approach (NIPPs) to address the underlying causes of malnutrition at community level. The team also trained more than 6,400 individuals in various sanitation and hygiene practices, while 20 boreholes and two deep wells were repaired in Buhera District that served to greatly improve water access for the communities in question.